1. IHE Eye Care “Charge Posting”
Donald Van Syckle DVS Consulting, Inc.

2. Charge Posting Profile: Features
Facilitates Collection of Procedure Details for Billing
Performed Procedure Technical Fees
Materials Usage
Future - Reporting Professional Fees
Etc.
Facilitates Management of Account Details in Multiple Systems and Procedure Records
June, 2006

3. Benefits Reduces Billing Errors Ensures Complete and Consistent Data
Less Billing Resource Requirements
Reduces System Interface Installation Time
Reduces the Need of the Billing System to Have Knowledge of Eye Care System
Eliminates Redundant Data Entry and Maintains Data Integrity
Provides Operational Cost-effectiveness
June, 2006

4. RESULT
Charge Processor will receive more complete, timely and accurate data.
June, 2006

5. Types of Billing Charges
Technical Charges
Fees for the actual procedure
Typically eligible at procedure completion
Information on materials used
Professional Charges
Not being addressed this year, but plans to add soon
Ensuring the required data is complete is the responsibility of the Charge Processor and is outside the scope of IHE and will be determined by the clinic policies
June, 2006

6. Workflow PMS BILLING SYSTEM Acquisition Modality EMR
Initial Capture of Patient Demographics
Patient Information
PMS
Registration
Account Complete
BENEFITS
Procedure Information
Redundancy Eliminated
Orders Placed
Maximum Data Integrity
Billing Available ASAP
All Systems Updated
Acquisition Modality
EMR
June, 2006

7. Technical Details HL7 Messages manage account details between systems
Open, Update, Close Account
DICOM Performed Procedure Step Messages (MPPS) provide details to Order Filler from the modality:
Performed (Billable) Technical Activities
Usage of Materials
HL7 Messages allow Order Filler to post charges to the Charge Processor (financial system)
June, 2006

8. Transaction Diagram
June, 2006

9. Workflow
Charge Processor receives patient/account information from ADT/Patient Registration
An order is generated for the patient and a procedure is performed on a Acquisition Modality (part of SWF)
ORM, MWL, MPPS, ……
DSS/Order Filler indicates to the Charge Processor that procedures are available for billing (using HL7)
Charge Posted Transaction may be sent at various times in the workflow
Regulations and site policies determine when a procedure is eligible for Charge Posting
June, 2006

10. Account Management Transaction
Collects information relevant to the patient account
and submits it to the Charge Processor
June, 2006

11. Actor: ADT/Patient Registration
Sends the message whenever a patient is:
Pre-admitted
Admitted
Sends P01 event to add a new account
Sends P05 (update account) event used to update an existing account
Send P06 (end account) event used to close an account
Optional features
One or more DG1 segments - Patient’s Diagnosis
One or more GT1 segments – Guarantor Information
One or more IN1 segments - Insurance Information
June, 2006

12. Message Segment: P01 - New Account
BAR Segment
Billing Account
Chapter in HL
MSH
Message Header 2
EVN
Event Type 3
PID
Patient Identification
[{DG1}]
Diagnosis 6
[{GT1}]
Guarantor
[{IN1}]
Insurance
June, 2006

13. Message Segment P05- Update Account
BAR Segment
Billing Account
Chapter in HL
MSH
Message Header 2
EVN
Event Type 3
PID
Patient Identification
[{DG1}]
Diagnosis 6
[{GT1}]
Guarantor
[{IN1}]
Insurance
June, 2006

14. Message Segment P06 - End Account
BAR Segment
Billing Account
Chapter in HL
MSH
Message Header 2
EVN
Event Type 3
PID
Patient Identification
June, 2006

15. Actor: Charge Processor
Receives patient demographics, account info, etc. for ADT/Patient Registration
Receives the posted charges and serves as a component of the financial system.
Note: When and how the actual billing is trigger is is beyond the scope of IHE.
June, 2006

16. Actor: Department System Scheduler /Order Filler
Receives/Collects patient information through existing HL7 ADT messages (defined in SWF)
Upon a defined workflow action (i.e. MPPS from modality), makes procedures info available for charge posting
The actions/events that actually causes charges to post is defined by the actor
Maybe convert protocol codes to CPT codes
Maybe include diagnostic reasons for procedures (ICD) codes
Send charge message upon receipt of MPPS or require manual confirmation
Others……
June, 2006

17. Interaction Diagram
June, 2006

18. HL7 DFT Message Semantics
Describes a financial transaction transmitted between the DSS/Order Filler and the Charge Processor
DSS/Order Filler uses information from the Modality Performed Procedure Step Completed/Discontinued transaction to verify the procedure has been completed
Includes the DICOM Billing and Material Management Code Module which provides procedure, materials and devices information
DSS/OF maps information from DICOM world to HL7 world
The Charge Posted Transaction will transmit Detailed Financial Transactions (DFT) messages using the P03 event
May convert procedure information from MPPS to CDT codes, etc.
One or more PR1 segments shall be present if additional procedures, materials or devices are present (more then one modality)
June, 2006

19. Detailed Financial Transaction Message
Message Segments
DFT Segment
Detailed Financial Transaction Message
Chapter in HL
MSH
Message Header 2
EVN
Event Type 3
PID
Patient Identification
{FT1}
Financial Transaction 6
[{PR1}]
Procedure
June, 2006

20. Trigger Events Procedure Ordered Procedure Scheduled
Procedure Completed
Future will define Report events for professional fees
June, 2006

21. Actor: Charge Processor
Receives patient demographics, account info, etc. for ADT/Patient Registration
Receives the posted charges and serves as a component of the financial system.
Note: When and how the actual billing is trigger is is beyond the scope of IHE.
June, 2006

22. More information…. IHE Web site: www.ihe.net Technical Frameworks
ihe_eyecare_tf_TI_vol1_2006_06_01 (Trial Implementation version)
ihe_eyecare_tf_TI_vol2_2006_06_01 (Trial Implementation version)
ihe_tf_rev6.0ft_vol1_ FINAL (Radiology)
ihe_tf_rev6.0ft_vol2_ FINAL (Radiology)
ihe_CARD_tf_vol2_2.1_FT (Cardiology)
Standards used by IHE Eye Care
DICOM Standard
HL7 Standard
IHE Connectathon Oct at RSNA HQ
IHE Showcase at Nov AAO Conference
Vendor Products Integration Statements
June, 2006

23. June, 2006